What does it really mean?
For a long time when I heard the word “narcolepsy” I imagined an unfortunate person who would fall unconscious in the middle of the sentence and wake up the next day – an image based on River Phoenix character from the early 90s movie “My Private Idaho”. There was surprisingly little education on the subject of sleep disorder in medical school but fortunately I have opted to do a three- week elective at a sleep center during my residency where I have learned the truth about this condition.
How is it diagnosed?
Narcolepsy is suspected when a person is suffering from excessive sleepiness despite adequate amount of sleep and the diagnosis is made by performing a sleep study (polysomnogram) that is done during the night and then MSLT (multiple sleep latency test) which measures tendency to fall asleep during the day. The whole thing amounts to a rather involved and cumbersome test, the patients get a couple dozen electrodes glued to their heads and get to hang out in a hotel-like sleep suite for almost 24 hours.
Narcoleptics are all around us.
You too have probably seen quite a few people affected by narcolepsy – it may be the girl in your college class who used to sleep through most of the lectures, the guy at your work who tends to nod off during most of the conferences, the uncle who falls asleep on the couch watching a football game, a friend who is always complaining of being tired and not being able to get a refreshing sleep… It never occured neither to any of these people nor to anyone around them that their brains simply doesn’t function normally when it comes to sleep. Narcolepsy is one of the most under-diagnosed medical conditions, partially because the sleep deprivation – an alternative explanation to symptoms is so common that people accept their symptoms as part of life and may never find out that they are affected.
What causes narcolepsy?
The modern science of genetics attributes narcolepsy to a mutant gene that codes for a specific neutrotransmitter region. The disruption of proper function leads to abnormal regulation of sleep cycle sequences and often intrusion of REM sleep into wakefulness. People with narcolepsy also are prone to sleep paralysis, they are uncomfortably aware of not being able to move or see when they are asleep. They can also experience hallucinations when they either fall asleep or waking up. While helpful at hinting toward epilepsy, neither one of these symptoms is required to be present in order for diagnosis of epilepsy to be established, and they also can occur on occasion in perfectly healthy individuals.
How do you treat it?
For many years, the traditional medication for treatment of narcolepsy were amphetamine derived drugs, such as Ritalin. Lately, however there has been a surge of new drugs on the market, that are more specifically directed at the sleep wake cycle regulation (Nuvigil) and are less prone to abuse. Also there is a medication called GHB (the substance with a tainted past of a popular date rape drug in the 80s). It is sold under the brand name Xyrem. This medication induced deep stages of sleep, which are deficient in narcoleptics, and has been extremely effective in controlling the symptoms. The downside is that it is very tightly regulated and quite expensive.
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Allergies are very common. Most people experience allergies at one point or another. Allergies are exceedingly common in industrialized countries and particularly in urban areas, with up to 30% of adult population affected. Due to this overwhelming presence of allergies in our lives, we often tend to regard them as trivial matter. However, a fatigued person should not underestimate the impact this condition can have on their overall wellbeing.
How is allergy related to fatigue? Allergic rhinitis (in other words: nasal allergy) that persists over time, results in chronic inflammation of the mucosal lining of your nose. This, in turn, results in constant stimulation of your immune system, which can make you feel very tired. Another link between allergies and fatigue is their effect on sleep. Studies show that people who suffer from allergies do not get restful sleep. As we have discussed before, sleep disturbance is probably the largest culprit among all of the fatigue causes. Therefore, tackling your allergy symptoms can result in significant improvement of your fatigue as well.
Diagnosis. Nasal allergies are usually easy to diagnose but to figuring out the exact culprit is more difficult. There are blood tests available that test for antibodies to common seasonal allergens to determine which one may be responsible but they are not comprehensive.
1. Irrigation. The first step to combating allergies is daily nasal irrigation. You will need either a squeeze bottle or a neti pot to do that. You can prepare your own solution with non-iodized salt and baking soda or buy a sinus wash solution packages in the drug store (my ENT recommends NealMed brand). Then it is just the matter of figuring out the right technique and getting used to the process. The sinus wash will remove the inflammatory substances, allergens, viruses and other pollutants from your nose. It will also make it easier for your nasal medication to reach its target.
2. Nasal Steroids. Most doctors consider prescription nasal sprays to be the best first line therapy. There are several different types available. Nasal steroids (such as Flonase, Nasonex, Nasacort and many others) work very well, but only when used regularly and for prolonged period of time. Their side effects are considered to be rather minimal. Nasal anti-histamine sprays (Astelin, Patanase, Astepro,etc) begin to work immediately and relieve symptoms fast, but they do not reverse the inflammation like nasal steroids do. Oral anti-histamines (such as Claritin, Allegra and Zyrtec) mainly help with sneezing, watering eyes and runny nose but do not significantly affect nasal congestion or post-nasal drip. On occasion, doctors prescribe a medication called Singulair, which is more often used in children.
3. Decongestants. Pseudoephedrine (Sudafed) is still one of the best medications out there for immediate short-term relief of severe nasal congestion. In most states however, the Sudafed that is stocked on the pharmacy shelves contains a different ingredient (phenylephrine) and you have to ask the pharmacist for the “real thing” which they keep behind the counter. Keep in mind that Sudafed is not a good drug for people who have high blood pressure or enlarged prostate. It is better to stay away from using over the counter nasal sprays – they often result in rebound runny nose, which can be very difficult to treat.
4. Other. In more severe cases, a visit to allergist may be recommended to perform skin testing for various allergen and a treatment called allergy desentization. READ MORE ARTICLES ABOUT FATIGUE
We live in the world of sleep deprived people.
The sleep science has been booming with new and exciting data over the past few decades. Once recording brain waves during sleep became possible, we learned that there is slow wave sleep and REM sleep. Each one is very important to our wellbeing. During REM sleep, we experience dreams and our brain neurons are working hard at data clean up and storage. Lack of this type of sleep will result in impaired memory and concentration as well as decreased thinking capacity.
The slow wave sleep, is the dreamless “shut down” mode, which allows your body to undergo all the necessary housekeeping and maintenance. Vital hormones are produced during this time and molecules, and the buildup of toxic byproducts is eliminated on the cellular level. The mechanisms that govern our sleep are so complicated and enigmatic, that modern science still is only glimpsing into it, but even that glimpse is enough to convince us that the value of sleep is absolutely crucial to our well-being.
The role of sleep in medical illness.
Recent breakthrough in treatment of fibromyalgia, a condition associated with chronic pain, depression and severe fatigue, revealed that the disease had its root in lack of slow wave sleep. So even when the fibromyalgia patient sleeps more than eight or nine hours per day, their brain for a number of reasons spends less in the slow wave sleep than necessary. Among many other things, this results in decreased production of the very important neurotransmitter serotonin and decreased production of human growth hormone. The result is depressed mood, low energy and in fibromyalgia patients also causes increased sensitivity to pain. While not everyone is genetically predisposed to develop fibromyalgia, most people will feel the diminished lack of sleep to certain degree.
So how much sleep do you really need?
There are some people who require less sleep than others, usually due to their ability to go through sleep cycles with higher efficiency than others. Most people, however do require a minimum or seven or eight hours to complete the required amount of sleep cycles. If you always wake up to the alarm clock, you are probably interrupting one cycle in the middle; if you have trained yourself to wake up at certain time on your own then your then your brain will adjust to complete the cycle on time.